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Wednesday, February 13, 2008 2:00 PM

Newscast: Lead Story - The Nation’s 10 Most Expensive Medical Conditions

(opening music)

Rand: This is Healthcare 411 for the week of February 13, 2008.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Debra: I’m Debra James.

Rand: And I’m Rand Gardner.

Debra: Coming up.

Rand: A new survey reveals the nation’s 10 most expensive medical conditions.

Debra: A telemedicine project links rural care clinicians with their counterparts in the city.

Rand: And AHRQ Director Dr. Carolyn Clancy offers tips for taking medical tests and getting the high quality care you deserve.

Debra: More after this message from AHRQ.


[Begin PSA: Tips to Prevent Medical Errors]

Man: Okay, here’s your ham on rye, extra mayo.

Woman: Uh, I ordered the turkey on whole wheat with mustard!

Narrator: Messing up your sandwich order is one thing, but messing up your medical care is another. Medical errors are one of the nation’s leading causes of death and injury. But you can help avoid errors by being more involved in your health care. Get the fact sheet, "20 Tips to Prevent Medical Errors," by visiting ahrq.gov/consumer. A message from the U.S. Agency for Healthcare Research and Quality.

[End PSA]


Debra: Now the numbers.


Debra: A new survey by AHRQ reveals that treating the nation’s 10 most expensive medical conditions cost about $500 billion in 2005. Topping the list for expensive medical care is heart conditions, with an estimated spending of $76 billion in 2005. Heart conditions is closely followed by traumatic physical injuries at $72 billion and cancer treatment at $70 billion. Other expensive conditions making the list include mental disorders, including depression, and diabetes care. The data ranking the most expensive medical conditions and their costs comes from AHRQ’s Medical Expenditure Panel Survey, a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid.

Rand: If you’re familiar with telemedicine, you might know that it can help patients use technology to connect with their doctors. But what you might not know is that telemedicine can be used to help health care providers in rural areas keep up with the latest science and research. An AHRQ-funded project called Extension for Community Healthcare Outcomes - or ECHO - has been helping rural doctors and nurses in New Mexico keep up with the medical trends on Hepatitis C, substance abuse, rheumatology, diabetes, obesity and many other chronic conditions. Dr. Sanjeev Arora is the driving force behind this project and is with us to talk about this unique use of telemedicine. Thank you for joining us, Dr. Arora.

Dr. Arora: Thanks for inviting me.

Rand: First, would you explain what traditional telemedicine networks do and how Project ECHO is different?

Dr. Arora: Most telemedicine networks connect patients in remote locations with health care providers in larger areas or academic medical centers. So for instance, a patient in a rural area can consult with a specialist at an academic medical center or the patient can have a chest X-ray taken and this will be sent to a city where a radiologist can read it. Project ECHO is completely different from traditional telemedicine networks because it doesn’t connect patients to doctors. Instead, it connects rural health care providers with other health care providers in cities and academic medical centers. In this case, rural providers talk about their patients just the way doctors do during traditional medical rounds only this time it’s through a technology-based network, and they learn from each other while doing this. Also, providers in Project ECHO agree to use the same best practice protocols to manage chronic diseases. So there is a standardization of care and a monitoring of patient outcomes through this telemedicine network. An important component of the project is the collection and analysis of patient outcome data.

Rand: Who is in the ECHO network?

Dr. Arora: Currently, the network links 21 primary care clinics with the University of New Mexico’s School of Medicine in Albuquerque. These are rural community health clinics based at federally qualified health centers, prisons, the Indian Health Service, and we also have a site at the public health department.

Rand: How does Project ECHO provide services to these clinics?

Dr. Arora: When a rural clinic joins Project ECHO, we bring the staff members out to receive brief initial training in disease management at the University of New Mexico. Consequently, they join a disease-specific knowledge network that meets online for an hour or two each week for case presentation and discussion. Since the project’s launch in 2003, we have held more than 200 interactive audio-video disease-specific clinics involving case presentation and management of more than 2,500 patients.

Rand: Has Project ECHO made a difference in patient care?

Dr. Arora: Yes, certainly. More patients with chronic conditions that live in rural areas are getting access to best practiced health care. Patients don’t have to travel long distances to see specialists anymore, and they can get care where they live. We are actually very pleased to see that two thirds of the patients seen at our ECHO sites are minorities, versus less than half at the university clinics.

Rand: Dr. Arora, what about the clinicians? How has this affected their delivery of care?

Dr. Arora: They say it is making a huge difference in their practices. They are managing more patients with chronic diseases and gaining valuable treatment expertise.

Rand: So any future plans for the program?

Dr. Arora: Yes. We want to add new diseases to our knowledge networks, including lung disease and gastro-intestinal disorders. We also want to establish an international network for HIV care.

Rand: Dr. Arora, thank you for speaking with us.

Dr. Arora: My pleasure.

Rand: To find out more about this and other AHRQ-funded health information technology projects, go online to healthit.ahrq.gov. Up next, AHRQ Director Dr. Carolyn Clancy talks about medical tests and encourages patients to ask questions.


Debra: If your doctor ordered blood tests, X-rays, and other screenings but you weren’t sure why, would you ask questions? In this segment on Navigating the Healthcare System, AHRQ Director Dr. Carolyn Clancy talks about how asking questions when you are told to have medical tests is key to getting safer, higher quality health care. Dr. Clancy, welcome.

Dr. Clancy: Thank you for having me.

Debra: Dr. Clancy, why is it important to speak up if you don’t know why your doctor is ordering a particular test or if you don’t understand how it may help?

Dr. Clancy: Ultimately, you make the decisions about your body and your health care. But you need information to make the best, most-informed decisions. So ask questions! How is the test done? What kind of information will the test provide? Is this test the only way to find out that information? What of the benefits and risks of this test? Navigating the health care system is easier when you collaborate with your clinician and get the answers you need.

Debra: So, besides understanding why I might need the test, what else should I ask my clinician?

Dr. Clancy: It’s really important to ask your doctor if you need to prepare in any way for the exam. For example, should you avoid eating or drinking for a certain time period prior to the test? Also, if you are concerned, ask what the test will feel like and if there will be any discomfort. Ask if you’re going to be awake or asleep during the test and is there any type of recovery? If you’re planning on going back to work, you need to know this. Will there be any side effects? Another important question is How accurate is this test?

Debra: And what if I don’t feel like I really need the test?

Dr. Clancy: It is okay, it’s more than okay to question your doctor about a medical test and discuss why he or she thinks you need it. If you’re very concerned about it, seek a second opinion.

Debra: What about getting the results of the tests that I do choose to have?

Dr. Clancy: That’s a very important question. You should always ask your doctor’s office about its policy on informing patients about their results. Find out when they’ll be available, and whether they will call you or whether you are expected to call them. Don’t assume if you don’t hear anything that no news is good news. There should always be a follow-up even if it’s just so your clinician can tell you the test results were normal and there is no need for further tests at this time. Remember, quality matters especially when it comes to your health.

Debra: Dr. Clancy, thanks for joining us.

Dr. Clancy: My pleasure.


Rand: That’s it for this week. For more information on these and other health-related stories and topics go to www.ahrq.gov.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Rand Gardner, I’m Debra James. Please join us for the next edition of Healthcare 411.

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